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Augmentative and Alternative Communication Devices and Motor Neurone Disease

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Augmentative and Alternative Communication Devices and Motor Neurone Disease

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The TAPIB Research and Capability team take care to ensure the research presented is accurate at the time of writing. Due to the nature of our work, we are not able to ensure that all relevant research has been considered in the development of this document or that information remains accurate after publishing.

Contents

  • Augmentative and Alternative Communication Devices and Motor Neurone Disease [Page: ]{1}

    • Contents [Page: ]{1}

      • Summary [Page: ]{1}

        • Motor Neurone Disease		[Page: ]{2}

          Communication [Page: ]{2}

          Multidisciplinary Teams [Page: ]{2}

      •   AAC Device Assessments		[Page: ]{4}[

      • References [Page: ]{7}

Summary Multidisciplinary care is important in the assessment and management of motor neurone disease (MND).80%of individuals with MND experience communication difficulties at some point during thedevelopment ofthe diseas.AugmentativandAlternativeCommunication(AAC)devicesareassociatedwithhigherqualityoflifeforpeoplewitheMNAndtheircarers.

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AAC devices can be used for different forms of digital communication including text-to-speech, css access to web browsing emails social media etc All AAC device assessments should cover the individual’s present communication status cognitive language abilities challenges literacy abilities limitations ability use understand symbols as well physical ability challenge seating positioning visual spatial perceptual abilities challenges how implement system AAC usage Therefore may require mult-disciplinary approach. We did not find any evidence occupation therapist independently assess individuals MNDS assistive technology AT communicate specifically AACdevices Sources suggest speech communication individual MNDS assessed Speech pathologist that pathologist can most appropriate AAc device provide training their role occupationaltherapist includes ensuring AAc integrated other ATS setting up physically accessing AAAC see Section (3). The literature confirms assessment scripting AC individuals with benefits from multidisciplinary approach.

Motor Neurone Disease

MND group diseases affect nerve cells called motor neurons In MND nerves become damaged start die causing muscles weaken waste away (MNDA,2024c) Areas affected include nutrition respiration and communication(MNDA 2024b; National Institute Health Care Excellence NICE),19).

Communication

More than people will experience difficulty at some point in the disease trajectory (MNDA Australia.2021a)The of individuals deteriorate over period few months this one problematic symptoms according to living with MND Royal College Speech Language Therapists n.d.). There is early ACC intervention associated higher quality life for both patients carers(Royal College Speech &Language Therapists,n d.)

Multidisciplinary Teams

Overwhelming consensus literatures management difficulties experienced by requires coordinated mult-disciplinary approach (Motor Neurone Association (MNDA)),(25); MNDA Australia,(2021a; NICE, p. 11)

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A coordinated care approach can help people with MND live better for longer. Known as multidisciplinary care, t this involves engaging with a team of health professionals from a range of disciplines (MND Australia, [year not specified]).

According to NICE guidelines for assessment management of MND: The multidisciplinary team should include these professionals:

  • Neurologist
  • Specialist nurse
  • Dietitian
  • Physiotherapist
  • Occupational therapist
  • Respiratory physiologist or healthcare professional who assesses respiratory function
  • Speech-language therapist
  • Healthcare professional in palliative expertise provided neurologists/nurses/ specialist palliative care professionals([NICE], pp.[[start page],[end page]])

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Accessing systems for AAC devices can include a head pointer mouse, a track ball, a switch, eye-gaze or software systems. AAC devices can be used as part of an integrated AT system(Speech Pathology Australia, 2018, pp. 3-7). This means that any device designed to facilitate communication may also serve functions such as driving electronic wheelchairs, operating environmental control systems, accessing IT like mobile phones and computers(ASHAWIRE, 2021; Speech Pathology Australia, 2018a), among other uses including web browsing, social media access via email(Cambridge University Hospitals et al., 2023; Hemsley etal.*, 2017; MNDA, 2025). Almost all domestic activities involving interaction with others require some form of verbal exchange, making it essential in everyday life for individuals who need assistance communicating to have access not just language but specifically augmentative assistive technology(AAC) (Speech Pathology Australia, 2024b).

AAC Device Assessments

In their presentation at the ISAAC conference held by Boston Children’s Hospital on behalf of its Augmentative Communication Program from 2014, speech-language pathologists along occupational therapists were involved directly within team assessments aimed towards children requiring complex forms of non-verbal or low-tech methods of expression. The assessment process should cover: • Present status regarding current use of alternative modes; • Physical abilities and challenges faced during daily living tasks, • Seating arrangements that allow optimal positioning while using devices, • Visual-spatial perception skills necessary when navigating through digital interfaces, • Cognitive capabilities required alongside linguistic proficiency, • Literacy levels as well as any limitations encountered due lack thereof, • The ability to interpret symbols used across various platforms, • Environmental factors influencing device usability such as noise level or lighting conditions, • Implementation strategies tailored toward individual needs(Russel & Buxton). At heart lies four fundamental questions guiding these evaluations: What are this child’s communication requirements? How does he/she currently perform compared with peers in terms of verbal interaction? What obstacles hinder full participation despite existing strengths? And finally what tools can be best utilized given those constraints?(Russel etal., p. 8).

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The MND Association in the United Kingdom states that AAC service delivery can be complex and that the successful use of a system often relies on good teamwork at the assessment stage. Collaboration between speech therapy, speech language pathology (SLP), occupational therapy (“OT”) , cognitive rehabilitation services (CRS) together with physiotherapy should also be considered where necessary(MNDA).

Speech Pathologists

For individuals diagnosed with motor neurone disease (MND). Timely referral for SLP is important. The communication abilities of an individual suffering from MND should ideally be assessed soon after diagnosis and reviewed during each clinic visit.(MNDA; NICE p:36-8). Speech pathologist’s role includes advising strategies for communication, assessing appropriate communication aids/AAC devices based upon needs training users to their use & assisting access voice message banking( MNDA; NID Australia; Speech Pathology Australia). as part of Michigan Occupational Therapy Association (MiOTA), Smith et al presented on the roles of OT and SLP working together. They state that among other things, the SLP evaluates need for AAC(n.d.,p 47).

Occupational Therapists

In the MND Association’s guide endorsed by Royal College Of Occupational Therapist it states that an OT can help people living w/ MND participate in functional activities they find meaningful.Others include: optimising daily life work social participation leisure opportunities as long possible focusing what person finds most valuable, making home environment more accessible maximizing function mobility facilitating safe participation in functional activities posture positioning fatigue management conservation energy psychological cognitive behavioral strategies timely provision adaptive equipment current anticipated needs providing support around physical emotional spiritual issues including open discussions about planning ahead death dying helping adjust changing roles supporting individuals family members express choice control develop goals together.

References

[1] MNDA. “Motor Neurone Disease Guide” [online]. Available: https://www.ndis.gov.au/motor-neurone-disease-guide Accessed Date: 3 June 2025.

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  • support for family and carers throughout the course of the condition; also bereavement. (MNDA, 2022)

Communication Support:

The occupational therapist should collaborate closely with the speech language therapist to assess each person’s specific needs regarding their ability to communicate using various assistive devices or methods including:

  • Seating, positional adjustments at wrists/hands/fingers/heads/neccks; switches & pointing tools; mobile arms; tables that facilitate use of communication aids; equipment supporting computer usage like email/social media apps; environmental controls (MNDA). Additionally they may provide advice about home modifications, help choose specialized equipment, adapt it according to individual requirements, set up and evaluate communication systems (MND Australia).

The role in Assistive Accessible Communications includes assessing physical accessibility directly or indirectly selecting appropriate ATs such as environmental control systems integrated into personal computers/tablets (Nice/Russel&Buxton), depending on user’s capacity (Speech Pathology Australia).

Accordingly, there are three levels within Occupational Therapy: foundational practitioners assisting Speech Therapists select suitable AAC device(s); intermediate ones working together similarly but choosing best options; senior level focusing more critically evaluating refining solutions integrating multi-disciplinary input for optimal outcomes. This suggests involvement from both professions throughout this process.

Collaboration involves understanding client system access progress towards learning goals which can be supported by OTs alongside STs with seating positioning wrist supports switches pointers mobile arm support tables etc., as well as direct access to communication devices.

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• access and use of a computer, tablet, phone, apps, voice banking and environmental controls (MND Australia , 2021a).

Assistive Technology

MND Australia advise that a General Practitioner (GP) or multidisciplinary team can arrange referral to speech pathologist or occupational therapist who provide advice on how modify communication as symptoms progress; information about voice banking recommendations AT alternatives ways communicating ((MND Australia, p. 15)). They also state an occupational therapist/speech pathologist/physiotherapist advises AT items comfort mobility function independence carer safety(((MND Australia()p., .)) p. MND Australia states assessment for daily living undertaken occupation physiotherapy/pathology/nurse expertise availability professionals particular locality ensure provided meet identified need individual(MND Australia(,)b). No such statement made regarding assessment for AT communications.

References

American Speech-Language-Hearing Association ASHA(). Augmentative Alternative Communication AAC.ASHA.org Ashawire.(November 16,, ). What Are Key Considerations When Selecting High-Tech AAC?[leader.pubs.asha.org](https://leader.pubs.asha.org/do/10.1044/2021-high-tech-aac/full/#:~:text=In%20some%20cases%2C%20AAC%20devices%20can%20also,be% aasimpleandstraightforwardaspossible)Cambridge University Hospitals NHS Foundation Trust (September , ). Online Safety Clients Accessing augmentative alternative communication(AAC)[cuh.nhs.uk/patient-informationonline-safety-for-clients-accessing-]augmentative-and-alternativecommunicationaac: textManyofthesedevicealsosocialmediaando online networkingConlon C Zupan B (). The knowledge confidence attitudes Australian speech-language pathologists in augmentative and alternative communication children young people Journal Clinical Practice SpeechLanguage Pathology[doiorg//].Hemsley B., Balandin S Palmer Dann S () A call innovative social media research field of augmentativealternative communicationAugmentative and

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OFFICIAL For Internal Use Only Alternative Communication, 3*( extbf{1}), extbf{1}–‚. hhttps://doi.org/ extbf{ extit{1}}0. extbf{ extit{o} extit{i}hor.org/1/07434618.2016,26, Motor Neurone Disease Association ( extbf{MNDA}). (2) ACAc f o r MND..\nhttps://www.mndassociation.org/professionals/management-of-mnd/aac-for-md*n*d Motor Neurone Disease Association (MNDA). (2) Occupational therapy fom ne*t or motor neurone disease.<https://www.mndassociat ion.o rg/sites/default/files/2-11/Occupational%20therapy%20for%20MND.pdf>MND Australia.( 2, June ). Equipment & home modifications..<https://www.mndaustralia.org.au/mnd-connect/living-with-mnd/equipment-assistive-tec hnology-home-modifications>MND Australia.(2,June).Speech&communication..<https://www.mndaustria l org.a u/m nd-con ne ct/li vi ng-wi th -m nd/s pe ech-c om m un ic ation > M N D Au stral ia .( ’ , March ) .What is mo t or neu rone dise ase? <h ttp s:/ / www. mn daus tra li a.or g.u au/m nd-co nn ec/t/w hat-is-m nd/wha t-i sm ot o r-ne ur one-d ise-a se-𝗽> M ND A ust ra lia.(„‟, Ju ne) Dysarthria — c on mu ni ca tion.<https: //w w.w.md n daustr alia.o rg-au/mn d-conn ect/for-healt h-professionals-serv ice-providers/managing-symptoms/c omm unicat ion-in-mdnd>MN*D Austral i a.( 2, June ). Role of assistiv e tec hnol og y in MN D..<ht tp:s//ww w.nmdau strial io ru/aunnd-connect/for-health-profesion als-service-p rovider s/as sistive-tec hnology>MND Australia.(”,June).Motor Neurone Disease More Facts..<https://www.mndaustria l.org.au/getmedia/7ddb1ee3-6dl-4f4bfa - **60c44eb57097/M ore-Facts-about-MN D.pdf>National Institute for Health and Care Excellent (NI CE). (19 , July 23 ) . Motor neur one disease : assessment an d man agement.\nh ttps:/ / www.n ice.or g.uk/guidance/N G42/chapter/R ec om m end at ions#recognition-and-referral>Occupationa l Therapy A ust ralia.(„‟, March 3) . Capability Framework for O ccupati onal Therapists Working with Assist ive Technology.<h tt ps: //ota-dire ctus-pro*d-fedm h jdvaceq f3g7.a ustraliasoutheast-01.azurewebsites.net/assets/69464b7 e-𝗽-c5- 𝗼🇸𝗑𝗻𝗾𝗿🖣𝗺𝗼𝗾𝗼𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗽-41 82 -977c-€de� �🖣𞧔𞷲🦿𝗺𝗼𝗾𝗿𝗻𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗾𝗽- 19.pdf>Royal College of Speech & Language Therapists. (n.d.). Supporting people living with motor neurone disease.<https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/rcs lt-motor-neur one-factsheet.p df>Russell, S.S.& Buxton,J.C.(204,Access is the KEY to AAC: The Role o f OT [PowerPoint Slides]. International Society for Augmentative and Alternative Communication.Lisbon,€ AAC a nd MND Page 8of extbf{‚},\Page 50of ‛

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OFFICIAL For Internal Use Only Portugal. https://www.childrenshospital.org/sites/default/files/media_migration/f50061b5-a363-

b76-9b8e-5fec942f693d.pdf Smith, D., Underhill, K., & Ward, M. (n.d.). OT, SLP & AAC [PowerPoint Slides]. Michigan Occupational Therapy Association.
https://miota.org/docs/MiOTA_AAC_Presentation_Final_Copy.pdf
Speech Pathology Australia. (2018, September 14). Speech Pathology Australia’s Submission to the Joint Standing Committee on the National Disability Insurance Scheme Inquiry: Assistive Technology.
<a href=“https://www.speechpathologyaustralia.org.au/Common/Uploaded%20files/Smart%20Suite/Smart%20Library/7526676d-3f8d-47ce-8603-

<a href="#">0968d54eb5ac/SPA%20Submission%20NDIS%20AT%20FINAL%2014092018.pdf</a></p>

Speech Pathology Australia (